1. The Transition from Health as Cost to Health as Business Value Thomas Parry, Ph.D. President Integrated Benefits Institute

2. About IBI National, not-for-profit organization representing 1,100 organizations with 20 million employees Business value of workforce health. Linking absence, employee performance and productivity to business metrics Better measurement. Providing practical measurement strategies for linking employee health, care delivery and business outcomes Modeling tools. To give employers a way to estimate the economic burden of illness when they don’t have all the data Practical evidence. Using case studies to show employers what leading employers have done and how they’ve done it

3. A New Employer Setting ACA: Transition from tactics to strategy Show the C-suite the value of improved workforce health Dead end: attempting to control claims costs in separate program silos Looking for new strategies to improve workforce health, reduce lost time, enhance productivity and impact business Limited data, time and dollars

4. Where employers started: healthcare as cost of doing business Health Costs

5. The first response: cost shifting Health CostsPlan Design

6. Moving upstream: getting on the front end of cost Treatment Health CostsPlan Design Chronic Health Conditions Health Risks

7. Moving downstream: incorporating outcomes Treatment Health CostsPlan Design Chronic Health Conditions Health Risks Work Absence/Disability Work Performance Lost Productivity

8. Next: Encompassing a Broader View Treatment Health CostsPlan Design Chronic Health Conditions Health Risks Work Absence/Disability Work Performance Lost Productivity EE Health Behaviors & Engagement Corporate Culture & Structure Business Performance Wellbeing

9. Modeling What’s at Risk for Employers

10. FCE Data Sources Bureau of Labor Statistics Integrated Benefits Institute Center for Disease Control National Academy of Social Insurance Agency for Healthcare Research and Quality Kaiser Family Foundation Nicholson, Pauly, Polsky, et. al.

11. The economic impact of illness: case example 10,000 life hospital system Workforce  81% female  46% between 35-54  44% professionals, 20% service workers

12. Distribution of costs for employees: healthcare as silo

13. Distribution of costs for employees: adding payments to absent workers

14. Distribution of costs for employees: adding absence lost productivity

15. Distribution of costs for employees: including reduced performance

16. Translating Lost Time into Lost Productivity Degree of difficulty in replacing workers Time-value of output Degree of working in teams ** Source: Sean Nicholson, Mark Pauly, et al., "Measuring the Effects of Work Loss on Productivity with Team Production," Health Economics 15: 111-123 (2006).

17. The Opportunity Costs of Absence

18. Quantifying Financial Lost Productivity * Lost productivity – “the financial impact on a company when employees are not at work and fully functioning” Two components: absence and decrements in job performance (“presenteeism”) The Financial Impact of Absence  Wage replacement payments  “Opportunity costs” of ER’s response The Financial Impact of Presenteeism  Wage and benefit “overpayments”  Opportunity costs of resulting lost time ** Source: Sean Nicholson, Mark Pauly, et al., "Measuring the Effects of Work Loss on Productivity with Team Production," Health Economics 15: 111-123 (2006). 18

19. Linking Healthcare to Productivity Outcomes

20. Going Beyond Medical & Pharmacy to Absence and Presenteeism

21. Co-Morbidity and Lost Time

22. The CFO’s View of Health

23. MGM Mirage Case Study

24. IBI Health & Productivity Snapshot Results 1.8 lost days per FTE/Year 6.2 lost days per FTE/Year Lost worktime = 8 days per FTE/Year or $2,598 per FTE/Year in Lost Productivity

25. Lost-Time Improvement’s Impact on EBIDTA Reducing 1 lost day/FTE = $15 MM to EBIDTA* from Productivity Gains *Earnings before Interest, Depreciation, Taxes and Amortization

26. The Bottom Line Savings $15.0 MM Wall-Street Multiple 10.7X Outstanding Shares 284.3 M Gain in Stock Price $.56/share Principal Owner (56%) $90 MM One Day of Productivity Improvement

27. IBI Research: Making Health the CFO’s Business

28. Key Findings  CFOs are key participants in benefits decision making  Health is an organizational priority  Productivity is critical to bottom line but the role of health is less clear  CFOs understand health impacts financial performance  Internal information is most credible but critical information is lacking

29. Health’s Link to Financial Performance

30. What’s “Very Important” to Workforce Productivity Health

31. Strength of Health Culture

32. In a Health-Focused Culture Improving health is seen as very important to productivity Health’s impact on business goes beyond healthcare costs and includes sick leave, “opportunity costs” of health, turnover, and absence payments Broader information available to make investment decisions: EE satisfaction, health risks, performance impact, ROI

33. Linking Health & Financial Performance: Putting Results in the CFO’s Terms Healthcare costs Sick days Turnover “Opportunity costs” Absence payments

34. CFOs Desire Broad Health Information … But Often It’s Not Available

35. The Challenge of “Big Data” to Employers

36. Workforce Key Health Dimensions*  Financial (cost)  Program participation  Biometric screening  Health risks  Utilization  Preventive care  Chronic conditions  Lost worktime  Lost productivity  Employee engagement * Thomas Parry and Bruce Sherman, A Pragmatic Approach for Employers to Improve Measurement in Workforce Health and Productivity, Population Health Management, Vol. 15, No. 2, 2012

37. Dimensions & Dashboard Metrics DimensionSummary Metric Financial Program cost/EE Program participation EEs participating/All EEs Biometrics EEs reaching target/All EEs Health risks # of health risks/EE Utilization # EEs getting care/All EEs Preventive care # EEs getting screened/All EEs Chronic conditions # EEs w/ chronic conditions/All EEs Lost worktime # of lost workdays/EE Lost productivity Lost productivity $/EE Employee engagement Engagement score/EE

38. The Temporal Dimension Leading indicators Health risks Biometrics Chronic condition prevalence Treatment indicators Preventive care EE engagement Health services utilization Program participation Lagging indicators Financial Lost worktime Lost productivity

39. Thinking about Metrics as Hierarchies Dashboard metrics Component metrics Contributing metrics

40. For more information: Thomas Parry tparry@ibiweb.org 415-222-7282 tparry@ibiweb.org